(a) In order for the employer to receive the incentive in the second and third year of the approval period, an employer shall submit to the department an annual WSLPIP report and a verification.

1. (1) Insured employers shall send each annual WSLPIP report and verification to the department no later than 90 calendar days after its annual policy renewal date.
2. (2) Individually self-insured employers shall send each annual WSLPIP report and verification to the department no later than 90 calendar days after the end of the calendar year.

(b) Each WSLPIP report shall include:

1. (1) data for the applicable policy year;
2. (2) information on claim frequency and claim severity by employment class, and by type of injury (such as death, permanent total disability (PTD), permanent partial disability (PPD), temporary total disability (TTD), medical only), and changes in the employer’s experience rating modification factor;
3. (3) a confirmation that the employer has complied with all requirements of these regulations concerning the participation of employee representatives, including the designated employee representatives and the recognized representative of each collective bargaining unit, where applicable; and

4. (4) for a safety incentive program, the employer must provide a description of how the program improved and/or maintained workplace safety, including a description of any measures taken to reduce or eliminate injuries or illnesses. The description must also include:

   1. (i) new or improved safety measures implemented as a result of the program;
   2. (ii) investments in safety equipment;
   3. (iii) how and to what degree the program prevented and mitigated the severity and frequency of accidents occurring within the previous and current policy year; and
   4. (iv) the training and education provided to employees and supervisors about the program;

5. (5) for a drug and alcohol prevention program, the employer must provide a description of how the program reduced workplace injuries. This information must comply with all applicable privacy laws. The description must also include:

   1. (i) the steps taken to minimize injuries related to drug and alcohol use and abuse and related workplace injuries;
   2. (ii) how the program improved safety and reduced accidents;
   3. (iii) the number of individuals identified with drug and alcohol abuse problems, and the assistance, if any, provided to them; and
   4. (iv) the training and education provided to employees and supervisors about the program;

6. (6) for a return to work program, the employer must provide a description of how the program facilitated the return to work of injured employees. The description must also include the following:

   1. (i) the number of employees who returned to work pursuant to the program after suffering a workplace injury or illness and the lost time incurred for each employee;
   2. (ii) a description of any accommodations made which allowed injured workers to return to work under the program and the duration of the alternate duty assignment;
   3. (iii) the number of employees who did not return to work after suffering a workplace injury and the number of employees who could not return to work because of such injury; and
   4. (iv) the training and education provided to employees and supervisors about the program.

(d) The insured employer shall send a copy of the department’s written notification of review and approval in a timely manner to:

1. (1) the employer’s workers’ compensation carrier if the employer is insured; or
2. (2) the board if the employer is individually self-insured.